Visram Anisa S, Jackson Iain R, Almufarrij Ibrahim, Stone Michael A, Munro Kevin J
Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK.
Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Int J Audiol. 2025 Aug;64(8):773-783. doi: 10.1080/14992027.2024.2397716. Epub 2024 Sep 12.
Visual reinforcement audiometry (VRA) is a well-established behavioural test used to assess hearing in infants and young children. This scoping review aimed to summarise the evidence for different approaches to optimising and improving the effectiveness of VRA for clinical practice.
A pre-registered scoping review was conducted.
Fifty-nine original articles were included in the review.
The review identified a number of factors which improved response behaviour, such as increased variety and complexity of visual reinforcers, short reinforcer durations, and providing breaks. Intermittent conditioning, where as few as 50% of conditioning trials were rewarded, did not have an impact on response behaviour, and neither did the (suprathreshold) presentation level used during conditioning. More responses were achieved for younger (around 12 months) than older (around 18-24 months) infants. Once infants were developmentally ready to condition to play audiometry, this allowed for a more comprehensive hearing evaluation.
VRA is a successful behavioural hearing test for most infants of developmental age around 7-24 months, with well-established protocols describing its clinical implementation. Further evidence is needed to assess potential benefits of different reinforcers, different auditory stimuli (e.g. filtered familiar sounds), and technologies to assist response detection.
视觉强化测听法（VRA）是一种成熟的行为测试方法，用于评估婴幼儿的听力。本范围综述旨在总结不同方法优化和提高VRA在临床实践中有效性的证据。
进行了一项预先注册的范围综述。
该综述纳入了59篇原创文章。
该综述确定了一些改善反应行为的因素，如视觉强化物的种类和复杂性增加、强化物持续时间缩短以及提供休息时间。间歇性条件反射，即仅有50%的条件反射试验得到奖励，对反应行为没有影响，条件反射期间使用的（阈上）呈现水平也没有影响。与年龄较大（约18 - 24个月）的婴儿相比，年龄较小（约12个月）的婴儿获得的反应更多。一旦婴儿在发育上准备好适应游戏测听法，就可以进行更全面的听力评估。
VRA对于大多数7 - 24个月发育年龄的婴儿是一种成功的行为听力测试方法，有完善的方案描述其临床应用。需要进一步的证据来评估不同强化物、不同听觉刺激（如过滤后的熟悉声音）以及辅助反应检测技术的潜在益处。
